We will do our best to contact you the same or next business day following your request, but current response time may be delayed. If your pet is currently experiencing symptoms, please call our offices to speak with a staff member for the fastest service. Select a Location Select your closest state:* Choose your state California Colorado Florida Kentucky Maryland Massachusetts North Carolina Oregon Texas Virginia
Maryland* Please select your preferred location. If you already have an appointment, please select the location where your appointment is scheduled.
Colorado* Please select your preferred location. If you already have an appointment, please select the location where your appointment is scheduled.
Virginia* Please select your preferred location. If you already have an appointment, please select the location where your appointment is scheduled.
Massachusetts* Please select your preferred location:
Kentucky* Please select your preferred location:
California* Please select your preferred location:
Florida* Please select your preferred location:
North Carolina* Please select your preferred location:
Texas* Please select your preferred location. If you already have an appointment, please select the location where your appointment is scheduled.
Oregon* Please select your preferred location. If you already have an appointment, please select the location where your appointment is scheduled.
Appointments for TeleCardiology are provided by referral only and are available for asymptomatic (stable) pets as diagnostics are performed without direct onsite veterinary supervision and results are communicated to your pet's veterinary care provider. If you have not had a referral submitted on your pet's behalf and you are interested in scheduling with TeleCardiology by CVCA, please discuss with your pet's veterinary care provider if TeleCardiology is the best option for your pet. Has your pet's veterinary care provider submitted a referral for your pet?* Has this pet been to CVCA before?* Please put 'no' if you have NOT brought this pet to CVCA before, even if you have previously been a client with us.
Would you like to set up an appointment?* When is your appointment?*
Are you requesting a new appointment or a recheck?* Hidden
Do you have a preferred appointment date / time? Our hours are Monday-Friday 9 a.m. - 5 p.m. EST
Preferred Days (Optional) Preferred Days (Optional) Preferred Time (optional) Most offices are open Monday-Friday from 9 AM - 5 PM.
Maryland - Do you have a preferred doctor? No Preference/Next Available Annapolis - Richard Cober, DVM, Diplomate, ACVIM (Cardiology) Annapolis - Matthew Boothe, DVM, Diplomate, ACVIM (Cardiology) Annapolis - Dan Stern, DVM, Resident (Cardiology) Annapolis - Michael Hickey, DVM, Diplomate, ACVIM (Cardiology) Columbia - Kristin Jacob, DVM, Diplomate, ACVIM (Cardiology) Columbia - Dan Stern, DVM, Resident (Cardiology) Columbia - Steven Rosenthal, DVM, Diplomate, ACVIM (Cardiology) Frederick - Bill Tyrrell, DVM, Diplomate, ACVIM (Cardiology) Frederick - Brett Boorstin, DVM, Diplomate, ACVIM (Cardiology) Frederick - Kacie Schmitt Felber, DVM, Diplomate, ACVIM (Cardiology) Gaithersburg - Tim Cain, DVM, Diplomate, ACVIM (Cardiology) Rockville - Michael Hickey, DVM, Diplomate, ACVIM (Cardiology) Rockville - Kristin Jacob, DVM, Diplomate, ACVIM (Cardiology) Rockville - Dan Stern, DVM, Resident (Cardiology) Towson - Steven Rosenthal, DVM, Diplomate, ACVIM (Cardiology) Towson - Julia Shih, VMD, Diplomate, ACVIM (Cardiology) Towson - Sloane Everett, DVM, Diplomate, ACVIM (Cardiology) Towson - Jesse Miller, VMD, DVM, DACVIM (Cardiology) Towson - Kate Pouliot, DVM, Resident in Cardiology
Virginia - Do you have a preferred doctor? No Preference/Next Available Fairfax - Sarah L. Holdt, VMD, Diplomate, ACVIM (Cardiology) Fairfax - Stephanie Hoffman, DVM, Diplimate, ACVIM (Cardiology) Fairfax - Bonnie Lefbom, DVM, Diplomate, ACVIM (Cardiology) Fairfax - Lillian Shen, DVM, Resident in Cardiology Leesburg - William Tyrrell, DVM, Diplomate, ACVIM (Cardiology) Leesburg - Gina Pasieka, DVM, Diplomate, ACVIM (Cardiology) Leesburg - Brett Boorstin, DVM, Diplomate, ACVIM (Cardiology) Leesburg - Emily Suess-Radford, DVM, Resident in Cardiology Leesburg - Jennifer Welter, DVM, Diplomate, ACVIM (Cardiology) Richmond - Jess Weidman, DVM, Diplomate, ACVIM (Cardiology) Richmond - Emily Westphal, DVM, Diplomate, ACVIM (Cardiology) Richmond - Ryan Peiffer, DVM, MS, Resident in Cardiology Springfield - Jennifer Sidley, DVM, Diplomate, ACVIM (Cardiology) Vienna - Neal Peckens, DVM, Diplomate, ACVIM (Cardiology) Vienna - Bonnie Lefbom, DVM, Diplomate, ACVIM (Cardiology) Vienna - Nathan Boyd, VMD, Resident (Cardiology) Vienna - Stephanie Hoffman, DVM, Diplomate, ACVIM (Cardiology) Vienna - Lillian Shen, DVM, Resident in Cardiology
Texas - Do you have a preferred doctor? No Preference/Next Available Shoal Creek - Katie Meier, DVM, Diplomate, ACVIM (Cardiology) Shoal Creek - Julie Andrie, DVM, Diplomate, ACVIM (Cardiology) NW Austin - Julie Andrie, DVM, Diplomate, ACVIM (Cardiology) NW Austin - Julia Lindholm, DVM, Diplomate, ACVIM (Cardiology)
Oregon - Do you have a preferred doctor? No Preference/Next Available William Rausch, DVM, Diplomate, ACVIM (Cardiology) Courtney Smith, DVM, Diplomate, ACVIM (Cardiology) Gregg Rapoport, DVM, Diplomate, ACVIM (Cardiology) Meghan Allen, DVM, Diplomate, ACVIM (Cardiology)
Primary Owner First Name*
Last Name*
Preferred Pronouns: Preferred pronouns:*
Contact Information As provided in CVCA’s email confirming your appointment, have there been any changes to your home address or contact information?* Phone (Please Include Area Code)*
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Phone Type? Email*
Address*
Does anyone else have permission to make decisions on behalf of your pet?* Please list their name and contact information.*
Please list changes to your home address or contact information.*
Do you work in the veterinary profession? If you answered yes to the above, please list your position and place of employment.
Are you a member of the military on active duty? Do you have pet insurance?* Who is the provider and what is the policy number?*
Pet Information and Medical History Pet's Name*
Species of Pet* Date of Birth/Approximate Age*
Sex of Pet* Breed of Pet*
Color of Pet*
Please check this box if the patient is owned by a 501(c)(3) non-profit rescue, shelter or government agency (Military, ATF, USDA etc) If you answered yes to the above, please list the name & phone number for the rescue, shelter, or agency.
Name & Phone Number
Name of your primary care veterinarian practice? Please include the city the practice is located in:*
Who is your primary care veterinarian?*
Approximate date of last visit to your primary care veterinarian:*
Other veterinarian or specialist and approximate date of last visit:
Preferred Pharmacy (Name, address, phone number):
Do any of your pet's relatives have heart disease?* Yes No I don't know
Has your dog/cat had any extensive travel history or adopted/lived outside of your current state of residence, in particular to the southwestern United States or overseas?*
Are any surgeries or dentistries planned?* What is the primary reason for your pet's visit or referral?*
Please check any of the following symptoms your pet is experiencing.* Please describe the weakness/lethargy.*
When was the first episode of collapse? How many episodes has the pet had?*
What was the pet doing before, during, and after the collapse?*
How long did the collapsing event last?*
How long until the pet was normal (i.e. able to stand, walk and respond normally)?*
Please describe the vomiting.*
Please describe the diarrhea.*
Is your pet coughing?* How frequently are they coughing?* Daily Weekly Monthly
When did the cough start? Has it been getting worse since the cough was first noted?*
Have you noticed a change in pet's breathing rate or effort?* Please describe.*
Have you noticed a change in your pet's activity level or tolerance to exercise?* Please describe.*
How is your pet's appetite?* Is this a recent change in appetite?* When did the change start? Was it gradual or sudden?*
What commercial brand along with the flavor/variety food do you feed your dog/cat? If you feed a homemade or raw diet, please elaborate on what you are specifically feeding your pet? (Write below or upload a photo)
Please upload a photo of your pet's food, if commercial brand.
How is your pet's water consumption?* How is your pet's urination frequency?* What medications is your pet currently taking (including preventatives and supplements)?*
Please list medication name, dosage (in mg), and directions/usage for each medication. If none, say 'none'.
Is there anything else we should know prior to the appointment? (Pet temperament, previous issues, sedatives prior to exam today, any other concerns about his/her cardiac health for this appointment)?
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Counting the pet(s) that you would like to bring to CVCA, what species of pet do you own? Dog Cat Other
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If 'other', what other species of pet do you own?*
Cardio-Pulmonary Resuscitation (CPR): In the unlikely event that your pet should have Cardio-Pulmonary arrest while in our care, what are your wishes in regards to attempted resuscitation?* Please note that we will make every attempt to contact you. Please ask for us to explain these choices further if you have any additional questions or concerns.
TeleCardiology Services: I understand that the sonography scan will be performed by a registered sonographer and transmitted to a remotely located board-certified veterinary cardiologist and results will be discussed with my pet's veterinary care provider only. It will be the responsibility of the veterinary care provider who referred my animal for these consultatory diagnostic services to communicate all of the results and treatment recommendations to me as the owner/responsible agent of the pet named above, and the sonographer and CVCA team cannot communicate information regarding diagnosis or treatment. CVCA Telecardiology will NOT be able to speak directly to me as the animal owner regarding results or recommendations.*
Signature
Consent for transfer to Emergency Care: TeleCardiology is available for asymptomatic (stable) pets only as diagnostics are performed without direct onsite veterinary supervision. If our CVCA staff determines that your pet requires veterinary assessment, treatment, or care, your pet will be immediately transferred to the Flower Mound Veterinary Emergency & Specialty Center for evaluation and continued care. Your signature below provides authorization for CVCA's TeleCardiology services within these parameters.*
Signature
In the unlikely event that your pet should have Cardio-Pulmonary arrest while in our care, and is then transferred to the Flower Mound Veterinary Emergency & Specialty Center for evaluation and continued care, what are your wishes in regards to attempted resuscitation?* Please note that we will make every attempt to contact you. Please ask for us to explain these choices further if you have any additional questions or concerns.
Signature*
Sedation: The majority of our patients do not require sedation for any of CVCA's tests or procedures; however, in the uncommon event the doctor deems injectable sedation necessary for your pet, please choose one of the following:* Signature*
May CVCA offer treats to your pet during his/her office visit?* (Optional): Photo of Your Pet How did you hear about CVCA?* My primary care veterinarian Veterinary Hospital Facebook Website Community Event Online Search Friend/Neighbor
Contact Methods CVCA Marketing is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, you may consent to any of the following below.
You can unsubscribe from these communications at any time. For more information on how to unsubscribe, our privacy practices, and how we are committed to protecting and respecting your privacy, please review our Privacy Policy. Would you like to sign up for text message reminders?* Would you like to sign up for CVCA marketing emails?* This includes a pet owner-focused quarterly newsletter, event announcements, and any CVCA pertinent updates. Approx. 1 email every 2 months.
Photo Release - Can we take/use photos of your pet to highlight them on our Facebook page/social media/newsletter?* Signature, Release, and Agreement I have reviewed and understand CVCA's Protocol and agree to the adjusted workflow. I understand that payment in full is due at the time of service and under CVCA's guidelines agree to pay CVCA no later than 5:00 pm on the day that services are rendered. I agree to assume financial responsibility for all professional fees and understand that a service fee of 1.5% will be charged on any unpaid balance. CVCA may also recover reasonable attorney’s fees and court costs incurred as a result of my failure to pay in accordance with this authorization.
Signature*
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